The year 2025 has been a rollercoaster for HIV research and treatment, with both triumphs and setbacks that have left the medical community reeling. Despite significant progress in the fight against HIV since its identification in 1981, the past year has presented unique challenges that threaten to undermine these hard-won gains.
A Year of Challenges for HIV Care
The Trump administration's policies have had a profound impact on HIV care and prevention, sparking concern among healthcare professionals and researchers. When the administration took office in 2025, a series of sweeping changes were implemented, including a halt to global health funding, which encompassed the US President's Emergency Plan for AIDS Relief (PEPFAR). This pause in funding, though partially resumed under a waiver, caused significant disruptions to HIV treatment and prevention programs worldwide, particularly in the 55 countries supported by PEPFAR.
Kimberly Powers, PhD, an associate professor of epidemiology, highlights the devastating impact of these cuts: "The progress we had made against HIV as a public health threat over the last couple of decades has been severely undermined. Life-saving treatment may have been exempted from the funding hold, but the disruption to services and infrastructure has caused irreparable harm."
The cuts to the US Agency for International Development (USAID) have also had a major impact on PEPFAR, as explained by Marshall Glesby, MD, PhD, associate chief of the Division of Infectious Diseases. He notes that USAID has historically funded the infrastructure needed to implement PEPFAR, and its near elimination has led to disruptions in HIV diagnostic, prevention, and treatment services worldwide.
"PEPFAR is a vital initiative, supporting around 20 million people in over 50 countries by providing antiretroviral therapy and essential services to vulnerable populations. It has saved an estimated 26 million lives, and these cuts threaten to undo all that progress," Glesby emphasizes.
But here's where it gets controversial: the pausing or ending of funding for research grants, including those focused on HIV, has led to disruptions in both care and research. Glesby warns that the reduction in funding for HIV vaccine research, for example, could hinder progress at a time when newer approaches using mRNA technology are gaining traction.
And this is the part most people miss: the impact of these funding cuts extends beyond the immediate disruption. Powers, whose own research grant was paused due to cuts, explains the long-term consequences: "The loss of important scientific knowledge is devastating. We may never know what breakthroughs could have been made if these studies had continued uninterrupted."
Advancements Offer a Glimmer of Hope
Despite these setbacks, there were some bright spots in HIV research and treatment in 2025. One notable advancement was the FDA approval of lenacapavir (Yeztugo; Gilead Sciences), a long-acting injectable form of pre-exposure prophylaxis (PrEP) that only needs to be taken twice a year. This represents a significant reduction in injections compared to cabotegravir, which requires six injections per year.
Glesby explains the significance of lenacapavir: "While the original combination regimen of injectable cabotegravir and rilpivirine has been a popular option, there are logistical challenges to scaling up intramuscular injections in clinical settings. Lenacapavir, which only needs to be taken every six months, addresses these challenges and adds a powerful tool to our HIV prevention toolkit."
Powers agrees, but she also highlights the potential barriers to distributing lenacapavir: "In a system that has become more dysfunctional, it's hard to predict how lenacapavir will play out. The infrastructure and system are hampered, and it's concerning to think about whether the drug will live up to its promise."
Despite these challenges, the potential of lenacapavir to curb HIV incidence is encouraging, and it could pave the way for future research into long-acting injectables with even longer periods between injections.
Looking Ahead: A Promising Future, Despite Challenges
The future of HIV treatment and prevention remains promising, despite the setbacks of the past year. Glesby notes that drug development in HIV is an exciting area, with small studies testing the efficacy of once-yearly lenacapavir, once-weekly oral pills, and even monoclonal antibodies injected every six months.
However, challenges lie ahead. The Trump administration is reportedly looking to cut funding for the Ryan White HIV/AIDS Program, the nation's safety net for HIV care and treatment. This program, which educates healthcare providers and clinicians on treating HIV, would effectively be eliminated if these cuts are implemented.
Powers sums up the situation: "While there have been some bright spots and reversals of lost funding, it's hard to feel like we're out of the woods. The situation is likely to remain difficult for the foreseeable future. But I remain hopeful that the resilience and persistence of those working in this space will ultimately lead to an improvement in the situation."
The fight against HIV continues, and the medical community remains committed to finding solutions, despite the challenges posed by political decisions.
